Date Published: 10 February 2010
People need health and social care services that are more joined-up and person-centred, according to the CQC
Services have steadily improved overall but rising demand and pressure on finances make reform essential, according to the regulator
The Care Quality Commission today (Wednesday) applauded overall improvements over recent years, as it published its first annual report to parliament on the state of health care and adult social care in England.
But it cautioned that some services were lagging behind the pack and that there were areas of common concern across health and social care, notably keeping people safe and staff training.
CQC pointed out that services would be operating in a different environment in future, with pressure on finances adding to continuing increases in demand and rising expectations. It said that the next big challenge for health and social care is to accelerate efforts to make services more joined up and centred around people's needs.
Its report argues that joining up health and social care can deliver both better care and greater efficiency.
It calls for investment in services that maintain people's independence, by reducing the need for expensive hospital and residential care. For example, up to £2 billion could be saved annually from hospital budgets if each area were able to reduce the number of older people admitted repeatedly to hospital in an emergency, and the number of days these people spend in hospital, to the levels seen in the best performing areas of the country.
Drawing on the richest sources of information available, this is the first time that an independent regulator has looked simultaneously across both the health and social care sectors.
CQC also published a five-year strategic plan today, which sets out what it wants to achieve for people using health and social care services, and how it will go about it.
CQC's interim chair, Dame Jo Williams, said:
"Overall, there have been steady improvements and it is really important to celebrate that. Successes have come in areas that really matter to people such as reducing hospital infection rates and helping people live independently at home. But we are mindful of the fact that pockets of poor practice remain. This must be addressed. "
Turning to the future, Williams said:
" We all know that the context is changing. Trends such as increasing demand and rising expectations will be exacerbated by pressure on finances. That means we cannot go on as we are. To cope, we need some radical changes in the way that we organise and deliver services.
This means shifting the culture away from a one-size-fits-all approach to care that puts the needs of individuals and carers at the centre of everything. A key part of this will involve helping people maintain their independence and health."
" We hope providers and commissioners of services will seize on the information we are making available and use it to improve care for the people using their services."
The report's main conclusions are:
- Overall there has been major improvement, including in areas that
really matter to people. Sixty-three percent of NHS trusts, 77% of
adult social care providers and 95% of councils were rated ?good' or
?excellent' last year. Hospital waiting times in A&E and waits for
non-emergency care have been driven down, rates of MRSA and C.difficile have
reduced by 34% and 35% respectively compared with the previous year, and reporting
of serious incidents to the National Patient Safety Agency has improved greatly
from 922,552 incidents in 2007/08 to 1,061,934 in 2008/09. These figures show
that organisations have made progress in routinely reporting serious incidents
in order to learn and put things right. From 1 April it will be mandatory
for all organisations to do so.
More people had access to services that: help prevent unnecessary emergency admissions to hospital (148,000 in 2009, up from 80,000 in 2004); and services that help them return home quickly from hospital (157,000 in 2009 up from 112,000 in 2004). More people are supported to live independently at home, with 2.1% of people aged 65 and over living in care homes in 2009, compared to 2.5% in 2005.
- But some organisations lag behind the pack and there are areas in
which services frequently struggle to meet standards. The three key
areas of concern highlighted by CQC are:
- Safety - It is crucial that organisations report their mistakes or near misses (called ?incidents') so that they can learn and put things right. Despite national progress, the reporting rate of incidents varies significantly across organisations. Although 90% of patient contact takes place at GP practices, only 3,417 incidents were reported in the year to July 2009, compared to 693,700 from hospitals.
- Safeguarding (protecting people from harm) - Nine percent of NHS trusts did not comply with the minimum standard on child safeguarding (up from 4%). The vast majority of social care providers fully met standards relating to safeguarding procedures. There were major lapses in only 2% of services but this equates to 383 services.
- Workforce training - All types of organisations find minimum training standards hardest to meet, which includes things like basic training on safeguarding, life support and fire safety. In 2009, the standard requiring NHS staff to participate in mandatory training programmes had the lowest overall compliance rate of all standards, varying from 73% in ambulance trusts to 90% in mental health trusts. Eighty-six percent or less of adult social care services (such as care homes and home care agencies), meet minimum standards on training.
- Rising demand and pressure on finances make reform essential. A predicted 1.7 million more adults will need care and support in 20 years' time. This comes at a time where public finances will be stretched further. CQC says services must speed up progress in providing joined up care centred around people's individual needs to tackle these pressures. It says this will improve people's experiences, maintain their independence and make care more cost-effective.
It is even more crucial to accelerate efforts to join up care and give people more choice and control by making care person-centred.
- Joined-up care - Access to intermediate services that prevent emergency admissions and delayed discharges has improved. But there is an over 30-fold variation in the proportion of people whose discharge from hospital is delayed. Some older people are admitted to hospital as emergencies twice or more each year, which could be prevented if they were cared for better in the community. If each area were able to reduce the number of repeated admissions and length of time these people spend in hospital to that seen in the best performing areas, it would result in an annual saving of up to £2 billion to hospital budgets.
- Person-centred care - Person-centred care is more effective because the focus is on the individual's needs and maintaining their independence and health. The government has calculated that up to £2.7 billion per year could be saved by enabling people with long-term conditions, such as diabetes, to manage their conditions better, treating them closer to home and avoiding unnecessary hospital visits. There is some cross-over between this figure of £2.7 billion and the £2 billion saving from reducing hospital admissions highlighted above. This is because the £2.7 billion figure here also incorporates potential savings from avoiding unnecessary hospital visits, and instead helping people with long-term conditions to keep healthy. Therefore the two figures cannot not be added together.
An important part of centring care on people's individual needs and protecting their rights is giving people choice and control to make decisions. To do this people need adequate access to information about their conditions and treatment options. Nearly 99% of NHS trusts and over 80% of social care providers meet minimum standards on making information available. But, 21% of hospital inpatients said they were not given enough information about their condition or treatment, and 29% of people with disabilities using social care services said they were not communicated with in a way that helped them understand everything properly.
In 2008/09, 86,000 adults used Direct Payments from councils, allowing them full control to choose and purchase their own social care. But this accounts for only 4% of the overall gross expenditure on care. In 53 councils fewer than 5% of people receiving care use Direct Payments.
CQC will play its part in driving improvements to make care joined-up and person-centred, but providers should use these findings to drive change. CQC says from 1 April the new set of standards will help to form the foundations for the shift towards joined-up, person-centred care. The new standards are focused on outcomes and put people at the core of how services are regulated. CQC says it will identify serious issues by responsive and vigilant assessment and where it finds shortfalls in performance, it will act swiftly, using its enforcement powers where needed. This is alongside driving improvements through performance assessment and through special reviews and studies.
Source: The CareQuality Commission (England, UK).